A systematic review and meta-analysis of prophylactic medication of vestibular migraine

Yiannakis, Constantina Paulo; Hamilton, Leanne O W; Slim, Mohd Afiq Mohd; Kontorinis, Georgios

doi:10.1017/s0022215122001979

Cited by 4 publications

(2 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In another randomized study, flunarizine exhibited an improvement in the frequency and intensity of vertigo, although without comparable benefits for headaches [ 34 ]. A recent systematic review and meta-analysis conducted by Yannakis et al [ 35 ] evaluated the effectiveness of prophylactic medications for managing VM. The review included both randomized and non-randomized controlled trials.…”

Section: Discussionmentioning

confidence: 99%

“…Propranolol and venlafaxine were found to significantly improve VSS and DHI scores, with propranolol demonstrating the highest success rate of symptom control. Therefore, the authors suggest that propranolol should be considered the primary treatment option for VM, followed by venlafaxine, while other medications such as amitriptyline, flunarizine, and cinnarizine showed only potential improvement trends without reaching statistical significance [ 35 ]. On the contrary, a well-structured systematic review concluded that the lack of available trials to inform practical recommendations for the pharmacological prevention of VM represents a critical gap in the field [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine

Lovato,

Disco,

Frosolini

et al. 2023

Medicina

View full text Add to dashboard Cite

Background. Monoclonal antibodies (mAbs) directed against the calcitonin gene-related peptide (CGRP) or its receptor represented the first targeted and specialized approach to migraine prophylaxis. Nevertheless, they have been rarely considered in the treatment of vestibular migraine (VM). Our aim was to evaluate the effectiveness of anti-CGRP mAbs in VM patients who did not respond to conventional migraine treatments. Methods. Consecutive VM patients treated with erenumab were considered. As a comparison, we considered the same VM patients during conventional migraine treatments (i.e., propranolol, flunarizine, or valproic acid), which were tried before mAbs therapy. Videonystagmography, the Italian version of the Dizziness Handicap Inventory (DHI) questionnaire, and migraine days over the last 3 months were evaluated in all patients before and after treatments. Results. In the present retrospective study, we included 21 female and 2 male VM patients, mean age 45.2 years. All patients underwent contrast-enhanced magnetic resonance imaging that ruled out other causes of vertigo. The DHI questionnaire significantly improved after mAb therapy (p < 0.0001). Mean migraine days over the last 3 months were significantly reduced after treatment (p = 0.001). Videonystagmography was altered in 11 (48%) patients prior to monoclonal antibodies. We found vertical positional nystagmus in 9 patients and horizontal positional nystagmus in 2 patients. After the treatment, we found vertical positional nystagmus only in 1 patient (p = 0.002). When patients were treated with conventional therapies, there was no significant reduction in DHI, and instrumental vestibular examinations remained altered. Conclusions. VM patients using anti-CGRP mAbs experienced a reduction in the dizziness-derived handicap, as reported in the DHI questionnaire. Furthermore, these treatments were significantly associated with a normalization of vestibular instrumental analysis. These findings were not seen with conventional treatments. Treatment with anti-CGRP mAbs may be effective in VM patients who did not respond to conventional migraine treatments. These findings should be tested in large, randomized clinical trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine

Lovato,

Disco,

Frosolini

et al. 2023

Medicina

View full text Add to dashboard Cite

show abstract

Optokinetic stimulation for the treatment of vestibular and balance disorders: a systematic review with meta-analysis

Obrero-Gaitán,

Sedeño-Vidal,

Peinado-Rubia

et al. 2024

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

Objectives To analyse the effectiveness of optokinetic stimulation (OKS) for improving symptoms and function in patients with vestibular and balance disorders. Methods PubMed (MEDLINE), SCOPUS, Web of Science (WOS), CINAHL Complete, and PEDro databases were searched to identify randomized controlled trials (RCTs) that included patients with vestibular and balance disorders and compared the effects of OKS versus other interventions or no intervention on subjective or objective functional outcomes. Data were analysed by the standardized mean difference (SMD) and its 95% confidence interval. Results A total of 10 studies were selected including 468 patients, 177 of whom received OKS. There were no significant differences in scores on the Dizziness Handicap Inventory (DHI) (SMD = 0.02; 95% CI − 0.18 to 0.23; p = 0.83) or the visual analogue scale (VAS) for vertigo (SMD = 0.16; 95% CI − 1.25 to 1.58; p = 0.82). However, there were statistically significant differences in the timed up and go (TUG) test, with a large effect (SMD = − 1.13; 95% CI -2 to − 0.28; p = 0.009), and in the sensory organization test (SOT), with a medium effect (SMD = − 0.7; 95% CI − 1.21 to − 0.19; p = 0.007). Subgroup analysis showed significant effects of OKS on VAS (p = 0.017), TUG (p = 0.009) and SOT (p = 0.001) only in patients with balance disorders without vestibular disease (p > 0.05). Conclusions OKS may improve dizziness intensity measured with VAS or dynamic balance measured whit TUG and SOT in patients with balance disorders not due to vestibular disease. The quality of the evidence was low or very low due to the small number of included studies. PROSPERO Registry number CRD42023445024.

show abstract

Monoclonal Antibodies Targeting CGRP to Treat Vestibular Migraine: A Rapid Systematic Review and Meta-Analysis

Frosolini,

Lovato

2024

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

Vestibular migraine (VM), a subtype of migraine characterized by vestibular symptoms, poses a significant diagnostic and therapeutic challenge. This study aimed to evaluate the effectiveness of monoclonal antibodies targeting Calcitonin Gene Related Peptide (CGRP) in the treatment of VM. Therefore, we conducted a rapid systematic review and meta-analysis following PRISMA and Cochrane guidelines. A search of databases (PubMed, Scopus, Cochrane and Google Scholar) was performed in October 2023. Inclusion criteria required original research articles focusing on patients diagnosed with VM and utilizing CGRP-targeting monoclonal antibodies. We performed qualitative assessments of study design, patient characteristics, and outcomes and, for studies with comparable outcome measures, a meta-analysis was conducted. Our search yielded four relevant studies, including cohort studies and a case report, totaling 99 patients. Proper vestibular instrumental tests were employed in half of the studies. Overall, the included studies reported significant improvements in VM symptoms. Our quantitative analysis, focused on migraine symptoms, demonstrated a substantial reduction in Monthly Days with Migraine at 6 months following treatment. No severe adverse drug reactions were reported. In conclusion, this rapid systematic review and meta-analysis provide preliminary evidence for the efficacy of CGRP-targeting monoclonal antibodies in treating Vestibular Migraine. However, the absence of randomized controlled trials and variations in study designs and diagnostic criteria introduce some limitations. Further research is needed, including controlled trials, to establish a more robust evidence base. Nonetheless, this treatment approach offers hope for the effective management of VM, potentially enhancing the well-being of affected individuals and reducing their associated disability.

show abstract

A systematic review and meta-analysis of prophylactic medication of vestibular migraine

Cited by 4 publications

References 42 publications

Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine

Monoclonal Antibodies Targeting CGRP: A Novel Treatment in Vestibular Migraine

Optokinetic stimulation for the treatment of vestibular and balance disorders: a systematic review with meta-analysis

Monoclonal Antibodies Targeting CGRP to Treat Vestibular Migraine: A Rapid Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About